Appeals Technician (Healthcare)

TL;DR

Appeals Technician (Healthcare): Processing incoming first, second level, and external appeals for pharmacy benefit management with an accent on quality standards and HIPAA compliance. Focus on verifying case qualifications, coordinating with pharmacists and medical directors, and managing external review organizations.

Location: Remote (US). Must be able to work 12pm-9pm EST hours.

Salary: $60,000 - $98,500 USD (depending on location)

Company

An enterprise health technology company providing PBM and health benefit management solutions via the cloud-native JUDI® platform.

What you will do

• Manage incoming first, second level, and external appeals requests for Commercial, Exchange, and Medicare lines of business.
• Verify if cases meet qualifications for appeal review and perform quality checks in accordance with policies.
• Maintain productivity standards and meet established turnaround time requirements.
• Coordinate with appeal pharmacists and submit case information to independent review organizations.
• Conduct verbal outreach to members and providers to obtain necessary information for case reviews.
• Adhere to HIPAA guidelines and internal Standard Operating Procedures.

Requirements

• 1+ years of experience as a certified pharmacy technician in a managed care or PBM setting.
• Active, unrestricted certified pharmacist technician license.
• Ability to work 12pm-9pm EST hours.
• Must be based in the US.
• Strong detail orientation and organizational skills.
• Excellent oral and written communication skills.

Nice to have

• Experience working with commercial and medicare appeals.

Culture & Benefits

• Fully remote work environment.
• Part of a Certified B Corp™ committed to improving drug price visibility and patient outcomes.
• Opportunity to work with cutting-edge enterprise health infrastructure.